Improving the Performance Curve:            Spring, 2006

                                 Newsletter of The Institute for Behavioral Healthcare Improvement

   (IBHcI)

 

Welcome and Perspective

 

This is the initial publication of Improving the Performance Curve , the Newsletter of the Institute for Behavioral Healthcare Improvement (IBHI). Our goal is to publish an update quarterly on progress, accomplishments and key connections. With each Newsletter we will feature one key program imitative either from IBHI's collaborative work or connection. With this issue we are pleased to highlight the National Program Meeting for the Depression in Primary Care Collaborative meeting held February 16-17, 2006 (see below).

 

IBHI is a newly organized, not-for-profit organization, dedicated exclusively to the quality of mental health and substance use care in the United States. To find the board of directors and other information visit our website at www.ibhci.org   IBHI is a knowledge-transfer organization.  Our Aim is to work collaboratively with health care and improvement organizations, purchasers, foundations and government agencies to markedly improve the quality and outcome of care and demonstrate value in behavioral health care.

 

The title comes from an article by Atul Gawande, M.D. published in the December 6, 2004, New Yorker, which described the role of the breakthrough collaboratives and Pursuing Perfection programs of the Institute for Healthcare Improvement (IHI) in improving outcomes for patients with cystic fibrosis.  The article describes an aggressive, patient centered, organizational quality process, driven by leaders seeking the most effective care.  For IBHI the article created a comparison of what it means for clients and providers to receive and provide the best versus average care.  As we have shared the article with professionals in the last year we have usually heard: “This type of effort should exist in behavioral health care.  You could substitute Bi-Polar Disorder, Depression, or Schizophrenia for Asthma or Cystic Fibrosis.  There is a need for this approach.”  The article is available on our web site, www.ibhci.org

 

History

 

With this aim and hope for the future, IBHI was launched in 2004.  IBHI developed from a series of conversations and Expert Forums among leaders in behavioral health and healthcare quality, on the importance of creating a more robust, effective quality improvement mind-set and capability within behavioral healthcare.  The understanding grew from an appreciation of the impact of the Institute for Healthcare Improvement (IHI), and the need for a similar organization in behavioral healthcare (see www.ihi.org)  A series of  Expert Forums, supported by the Center for Healthcare Strategies, the Substance Abuse and Mental Health Services Administration, (SAMHSA), Amerigroup Foundation and the participating organizations, were held in late 2004 and spring and fall 2005, to frame a possible initiative.     

 

A cross-section community of interests is targeted to fully support IBHI goals of improved measured clinical outcomes, patient satisfaction and organizational results in behavioral healthcare.  Toward this end, a founding Board of Directors is in place, alliances with other like-minded groups are being established and learning and outreach efforts are under way.

 

Carrying on the Chasm Conversation

 

Outreach efforts have been built around the perceived need and generating a dialogue on a series of important reports over the last five years on healthcare quality by the Institute of Medicine (IOM).  In November, 2005 the IOM issued the third in its’ Quality Chasm Series, Improving the Quality of Health Care for Mental and Substance-Use Conditions.  The IOM Report held two over-arching recommendations:  first, that the aims and rules of the earlier Crossing the Quality Chasm report should be applied throughout M/SU health care on a day-to-day basis; and M/SU treatment must be provided recognizing the interrelation between mind/brain and the rest of the body (see: www.IOM.edu ). The Report folds earlier recommendations into specific areas for behavioral health care.  The IOM Report does not prescribe a method or specific actions, but does concisely reference the need for a strategic approach.  It followed two other landmark references The President’s New Freedom Commission (2003) (http://www.mentalhealthcommission.gov/reports/FinalReport/toc.html) and the SAMHSA Federal Action Agenda (2005) http://www.samhsa.gov/Federalactionagenda/NFC_TOC.aspx    which also called for focused action.

 

         IBHI’s Core Principles:   The essence of these reports and reflections by national experts has been distilled by IBHI to Core Principles which guide our action and planning:

 

• Health care quality is not nearly as good as it should be

 

• Our patient/clients deserve better

 

• It is exponentially easier to improve together than it is alone

 

IBHI believes the message of the IOM and other recent Reports, should be in active dialogue and within the various communities of interest which function, (often in their own chimneys) within Behavioral Health Care.  More importantly, the Reports are a call to action to make improvements. As an important early step, IBHI has engaged  in a series of Leadership Forums and presentations at  national and regional conferences  over 2006, in addition to work to build membership and support collaborative action.

 

Behavioral Health Care Track at the IHI Forum: Planning is underway for an advanced BHC Track at the IHI Forum December 10-13, 2006 in Orlando.  IBHI and IHI enjoy a strong working relationship, an informal partnership which guided the first Behavioral Healthcare Track at the December, 2005 IHI Forum.  IHI extended IBHI participants, discounts to existing IHI learning communities, and maintains a conversation about how to more fully integrate behavioral health care issues into longer range strategic planning.  Behavioral healthcare is increasingly recognized as important in dealing with other healthcare issues and diseases. SAVE THE DATES

 

IBHI Leadership Forums: across the nation IBHI will sponsor forums to help BHC leaders frame action from the challenges and opportunities posed by the recent IOM report(s), and ways to initiate system changes to realize them.  The first was co-sponsored with the Kaiser Foundation Health Plan March 6/7, 2006 in Oakland, CA. Another is targeted October 26-27 in Minneapolis, MN.  Developing a focused base of early adapter members is an important early step in IBHI development.  Overheads from the most recent event are posted the IBHI web-site, (www.ibhci.org )

 

IBHI has also participated in National and Regional learning sessions with the National Initiative for Children’s Healthcare Quality (NICHQ), the California Quality Improvement Council (CALQIC), the American College of Mental Health Administrators, the Depression in Primary Care Collaborative sponsored by RWJF and the National Council for Community Behavioral Healthcare (NCCBH);  These meetings offered some keen learning opportunities and readers are encouraged to visit the web-sites of these organizations web sites and review the presentations.  An abstract of the December, RWJ Depression in Primary Care Colloquium is contained as an appendix with the goal of sharing the results of this important five year program.

 

Target Learning Collaboratives:

IBHI has also been encouraged by interest shown in launching at least one of two targeted Breakthrough Collaboratives, one focused, on more effective care of mental and substance abuse patients in hospital emergency rooms the other on the issue of treating treatment refractive depression.   We are also seeking other areas where collaboratives might be organized, especially on: the need for attention to connections between mental health/substance use care and the criminal justice system; and building upon the early strides in children’s care in ADHD and in access to psychiatric care for children and adolescents.

 

Membership in IBHI is open to any person or organizations interested in development of quality improvement in the outcomes of mental and substance use treatment, and the integration of special and general health care services.  Annual memberships are offered to individuals and organizations at two levels and for sponsors or co-sponsors of Forums, Learning Collaboratives or other events.

                        Individual                                  $100 Regular / $500 Sustaining

                        Organizational                           $2,500 Regular / $5,000 Sustaining

                        Sponsors                                  $10,000 +

It is hoped this newsletter will be distributed quarterly. IBHI is now an incorporated not-for-profit organization.  It has a nine member board of directors, and a website www.ibhci.org

 

Membership is encouraged to participate in the planned IHI Forum in December and other IBHI events.  For more information, contact below and our web-site.

 

Feedback Please:

 

For more information, please contact the Co-Executive Directors:

 

Alden (Joe) Doolittle                                                                   Peter C. Brown

112 Maplewood Drive                                                                  18 Clove Road              

Scotia, New York 12302                                                             Castleton, New York 12033

Phone/fax:  (518) 384-1700                                                         Phone:  (518) 732-7178

Email:   aldenjoe@att.net                                                            Email:   Brownpcmd@att.net      

 

 

 

Appendix

 

Summary: Depression in Primary Care: Linking Clinical and Systems Strategies

National Program Meeting; February 18-17, 2006

 

One of the program’s objectives has been to build and support quality improvement initiatives that build bridges to better integrate behavioral health and general medical care. Depression in Primary Care (DPC) has sponsored national meetings since 2003 that have brought together a variety of stakeholders and researchers interested in improving care for patients with behavioral health and chronic medical conditions.  While it isn’t possible to provide a complete summary of the Depression in Primary Care Final Annual National Program Meeting, here is at last a partial summary of the more pertinent parts.  All of the materials referenced below are usually available from the Depression in Primary Care website www.depressioninprimarycare.org.  Depression in Primary Depression in Primary Care is a national program supported by The Robert Wood Johnson Foundation with direction and technical assistance provided by The Department of Psychiatry, University of Pittsburgh School of Medicine.

Keynote:Lessons Learned from the Depression in Primary Care National Program
Harold Alan Pincus, MD - DPC National Program Office

 

Dr. Pincus provided an overview of the results demonstrated by the initiative:        

• Depression is a serious and prevalent chronic disease (especially in primary care)
• Longitudinal chronic illness care models are effective but not currently implemented
• Multilevel clinical and economic/system strategies are needed to overcome barriers among target groups (“6 Ps”)[1]
• There are special barriers in “mainstreaming” behavioral health quality initiatives

      

He pointed out there are 10 different groups[2] which need to be considered in the development of top quality care.  The original 6 Ps have expanded to 10.  He indicated, “We will not get improvement without specific initiatives. We need inter-operability, synchronicity and alignment of purpose both vertical and horizontally.  In addition we probably need ruthless care managers.” In summary he suggested under Planning for the Future the following approach:

 

1. Get behavioral health on the radar screen

–        Create / support purchaser/regional collaboratives

–        Assure inclusion of behavioral health

2. Provide leadership to infuse modern performance improvement strategies into behavioral health

–        Quality infrastructure is seriously underdeveloped and fragmented

–        Need integrative entities to diffuse learning (purveyors)

3. Accelerate production of robust behavioral health measures

–        Standardization across silos

–        Measures of collaboration

4. Establish mechanisms to reward performance distinction

–        Behavioral health not part of current P4P initiatives

–        Accountability / alignment – incentivizing “de-fragmentation”

5. Study/fund research to:

–        Document stakeholder value

–        Evaluate effective implementation strategies

–        Translate from bench to bedside to community

 

In all over 43 presentations, were made over the two days, and we encourage you to review the PowerPoint Presentations on the DPC web-site, www.depressioninprimarycare.org.  Of special note were several presentations on the Pay-for-performance, a presentation by employers and the Network for Improving Addiction Treatment  (http://www.niatx.org/)  Here are he speakers and the internet connections:

 

Pay-for-Performance in Behavioral Health
Sarah Scholle, DrPH, MPH - National Committee for Quality Assurance
Neil Korsen, MD, MS - Maine Medical Center
Mitch Feldman, MD, MPhil - University of California/San Francisco

 

Getting Your Dollar’s Worth: The National Business Group on Health Employer Toolkit for  Quality Purchasing of Mental Health Care:

Ron Finch, EdD - National Business Group on Health
Dan Conti, PhD and Wayne Burton, MD - JP Morgan,Jack Mahoney, MD, MPH - Pitney Bowes
Henry Harbin, MD - Magellan

 

The workshop on Getting Your Dollar’s Worth was chaired by Ron Finch of National Business Group on Health, and featured speakers from JP Morgan Chase and Pitney Bowes.  In each case the industry representative spoke of their efforts to organize and maintain good behavioral health care to reduce morbidity, absenteeism and “presenteeism.”  This latter term describes the phenomenon of employees who show up for work but are unproductive for various behavioral health reasons.  The three business representatives pointed out the very large expense businesses incur from this morbidity, and their ground breaking work to advance good care to reduce these costs, and improve worker well being.  This workshop was especially important for the clear demonstration of the benefit to the payers, or businesses, of having a good behavioral health program.  It is clearly more economically beneficial to have a good behavioral health program than to either avoid the issue completely or try to get rid of workers with problems and rehire and retrain replacements.

Improving Mental Health & Substance Use Treatment Effectiveness & Efficiency through

Technology David Gustafson, PhD - University of Wisconsin (NIATx)  NIATx focuses on improving access to and retention in substance abuse programs.  The program has a well established collaborative in this area, which has demonstrated some real success, and is expanding it’s network idea to State based initiatives.

 

The program concluded with some poignant stories of specific efforts for self help and mutual support, and a hope that what has been learned in the study would continue to be valuable in the future.

 

Peter C. Brown